Healthcare Provider Details

I. General information

NPI: 1922506161
Provider Name (Legal Business Name): WEST VIRGINIA VASCULAR INSTITUTE PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/23/2018
Last Update Date: 06/11/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

250 STANAFORD RD STE 202
BECKLEY WV
25801-3140
US

IV. Provider business mailing address

250 STANAFORD RD STE 202
BECKLEY WV
25801-3140
US

V. Phone/Fax

Practice location:
  • Phone: 304-255-3601
  • Fax: 304-255-3340
Mailing address:
  • Phone: 304-255-3601
  • Fax: 304-255-3340

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number1595
License Number StateWV

VIII. Authorized Official

Name: HERBERT P OYE
Title or Position: OWNER
Credential: DO
Phone: 304-255-3601